Stockwood Medical Centre

Updated 28 December 2016

Stockwood Medical Centre, Holloway, Road, Bristol, BS14 8PT provides support for approximately 9248 patients in the Stockwood area of Bristol.

Stockwood Medical Centre is in a central position in the community of Stockwood. The practice building hosts NHS services such as the District Nursing Team The building is accessible to patients with restricted mobility, wheelchair users and using pushchairs.

There are eight consulting rooms, two treatment rooms and a treatment suite. The waiting room is accessible and in a central area. There are administrative offices, meeting and staff rooms.

There are five partners and one salaried GP, four male and two female. There are two nurse practitioners and three practice nurses and two health care assistants. The practice employs a pharmacist to attend the practice for 15 hours per week. The clinical staff are supported by a practice business manager and an administration team.

The surgery is open from 8.30 am to 6.30 pm, Monday to Friday. Appointments can be made via the telephone between 8.00am and 6.30 pm Monday, Wednesday or Friday and 8.00am and 7.30 pm Tuesday and Thursday. Patients who find it difficult to access a surgery during normal working the practice is open for additional hours 6.30 - 7.30 pm Tues and Thurs plus 8am – 10am every other Saturday for routine pre-booked appointments only.

The practice has a General Medical Services contract with NHS England. The practice is contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, patient participation, minor surgery and childhood vaccination and immunisation scheme.

The practice does not provide Out Of Hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the website.

Patient Age Distribution

0-4 years old: 6% (similar to the national average)

5-14 years old: 10% (similar to the national average)

The practice had 10.7% of the practice population aged 75 years and above (above the national average 7.6%).

Other Population Demographics

% of Patients in a Residential Home: 1.4 %

Disability Allowance Claimants (per 1000) 59 (above the national average of 50.3)

% of Patients in paid work or full time education: 58.7 % ( similar to the national average of 60.2%

Practice List Demographics / Deprivation

Index of Multiple Deprivation 2010 (IMD): 20.9 (National average 23.6)

Income Deprivation Affecting Children (IDACI): 18 (National average 22.5)

Income Deprivation Affecting Older People (IDAOPI): 16 (National average 22.5)

Updated 28 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stockwood Medical Centre on 16 December 2015. Overall the practice was rated as good with requires improvement for the safe domain. Following the inspection we issued a requirement notice. The notice was issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Safe care and treatment.

The issues were:

• There was not a robust system in place to ensure that the agreement by the clinical governance lead for Patient Group Directions had been recorded to allow nurses to administer medicines in line with legislation.

• Staff who provided chaperone support when clinical staff were not available had not had appropriate training and checks to evidence that background security had been undertaken were not in place.

• There were gaps in the information retained in the practice to show that appropriate checks were carried out on locum GPs employed at the practice.

A copy of the report detailing our findings can be found at www.cqc.org.uk.

We carried out this announced focused inspection at Stockwood Medical Centre on 28 November 2016 to follow up the requirement notice which was issued on 16 December 2015 and to assess if the practice had implemented the changes needed to ensure patients who used the service were safe.

Our key findings across all the areas we inspected during this inspection were as follows:

• We saw evidence the provider had ensured there were safe systems in place for Patient Group Directions. These were adopted by the practice to allow nurses to administer medicines in line with legislation and had been signed by the clinical governance lead for the nursing staff.

• We saw evidence the provider had ensured that an appropriate system was in place for locum personnel employed to carry on the regulated activities. The practice held the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• We saw evidence that the policy and procedure for providing chaperones had been reviewed and updated. We found staff carrying out the role were suitably trained and appropriate employment checks had been carried out.

Following this inspection the practice was rated overall as good across all domains.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was higher than the Clinical Commission Group (CCG) and national average (77.5%). For example, the percentage of patients with a diagnosis of diabetes, on the register, in which the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), was 82.7%.

Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 March 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 79.6%, which was comparable to the Clinical Commissioning Group (CCG) average of 81.8% and the national average.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 22 March 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 22 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 22 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for mental health related indicators was similar to the Clinical Commissioning Group (CCG) and national average. For example, the percentage of patients diagnosed with dementia whose care has been reviewed in a face to face review in the preceding 12 months was 83%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.